• Etiologies include:
• Branchial cleft remnants
-Present most commonly as cysts later in childhood
-Sinuses, fistulae, and cartilage remnants present at birth
-Second branchial cleft remnants most common
• Thyroglossal duct cyst presents later in childhood
• Benign lymphadenopathy most common neck mass of childhood
• 65% of lymphangioma and cystic hygroma are present at birth and 80% are present by age 1
• Branchial cleft cysts
-Present later in childhood when secretions build up, occasionally with erythema and tenderness due to infection
-Present from angle of mandible (first cleft) down to lower third of sternocleidomastoid (second cleft) with fistulas being present to external auditory meatus (first), tonsillar fossa (second), pyriform sinus (third and fourth)
-Masses or cysts can present anywhere between fistula openings and internal cleft sites
• Thyroglossal duct cyst
-Presents as midline cystic neck mass usually overlying hyoid
-Often moves during swallowing or draining sinus in early childhood
-Occasionally presents as painful draining mass if infected
• Suppurative lymphangitis: Presents as painful, erythematous, draining mass following an upper respiratory tract infection
• Hemangiomas: Become apparent after first few weeks of life usually as blue, spongy, rubbery, and sometimes extensive in cutaneous regions or airway
• Lymphangioma and cystic hygroma: Typically present as asymptomatic mass anywhere in body but have a high tendency to become infected
• History and physical exam
• Barium injection of fistula tract for branchial cleft fistula
• CT for suspected branchial cleft remnants
• US with duplex for some masses difficult to diagnose
• Incision and drainage of branchial cleft cyst if infected
• Dissection and excision of branchial cleft cyst or fistula once infection resolved
• Thyroglossal duct cyst excision including midpoint of hyoid and tract up to base of foramen cecum
• Incision and drainage of suppurative lymphangitis if initially unresponsive to antibiotics
• Excisional biopsy for enlarged lymph node present > 8 wks, larger than 2 cm, firm, immobile
• Excision or sclerotherapy of lymphangioma or cystic hygroma
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